EP0693274B1 - Implant for maintaining the normal spacing between two vertebrae - Google Patents

Implant for maintaining the normal spacing between two vertebrae Download PDF

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Publication number
EP0693274B1
EP0693274B1 EP95107289A EP95107289A EP0693274B1 EP 0693274 B1 EP0693274 B1 EP 0693274B1 EP 95107289 A EP95107289 A EP 95107289A EP 95107289 A EP95107289 A EP 95107289A EP 0693274 B1 EP0693274 B1 EP 0693274B1
Authority
EP
European Patent Office
Prior art keywords
implant
characterised
openings
terminal
sleeve
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Lifetime
Application number
EP95107289A
Other languages
German (de)
French (fr)
Other versions
EP0693274A1 (en
Inventor
Helmut Dr. Schönhöffer
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Ulrich Heinrich
Original Assignee
Ulrich Heinrich
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority to DE19944423257 priority Critical patent/DE4423257C2/en
Priority to DE4423257 priority
Application filed by Ulrich Heinrich filed Critical Ulrich Heinrich
Publication of EP0693274A1 publication Critical patent/EP0693274A1/en
Application granted granted Critical
Publication of EP0693274B1 publication Critical patent/EP0693274B1/en
Anticipated expiration legal-status Critical
Application status is Expired - Lifetime legal-status Critical

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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/44Joints for the spine, e.g. vertebrae, spinal discs
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2/4611Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof of spinal prostheses
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108Shapes
    • A61F2002/30199Three-dimensional shapes
    • A61F2002/30224Three-dimensional shapes cylindrical
    • A61F2002/3023Three-dimensional shapes cylindrical wedge-shaped cylinders
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    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2002/30235Three-dimensional shapes cylindrical tubular, e.g. sleeves
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    • A61F2002/30329Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30405Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by screwing complementary threads machined on the parts themselves
    • A61F2002/30411Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by screwing complementary threads machined on the parts themselves having two threaded end parts connected by a threaded central part with opposite threads at its opposite ends, i.e. for adjusting the distance between both end parts by rotating the central part
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    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2002/30329Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30476Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism
    • A61F2002/30507Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism using a threaded locking member, e.g. a locking screw or a set screw
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    • A61F2002/30535Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30537Special structural features of bone or joint prostheses not otherwise provided for adjustable
    • A61F2002/3055Special structural features of bone or joint prostheses not otherwise provided for adjustable for adjusting length
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    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
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    • A61F2002/30535Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30574Special structural features of bone or joint prostheses not otherwise provided for with an integral complete or partial collar or flange
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
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    • A61F2002/30535Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30601Special structural features of bone or joint prostheses not otherwise provided for telescopic
    • AHUMAN NECESSITIES
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    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/30767Special external or bone-contacting surfaces, e.g. coating for improving bone ingrowth
    • A61F2/30771Special external or bone-contacting surfaces, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
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    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
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    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • YGENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10STECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10S606/00Surgery
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Description

Implantat zum Einsetzen zwischen Wirbelkörper der Wirbelsäule als Platzhalter. Implant for insertion between vertebral bodies of the spinal column as a place holder.

Die Erfindung betrifft ein Implantat zum Einsetzen zwischen Wirbelkörper der Wirbelsäule als Platzhalter für aus der Wirbelsäule entfernte Wirbel oder Wirbelteile, bestehend aus zwei endständigen, zur Anlage an den angrenzenden Wirbeln bestimmten Implantatteilen und einem dazwischen befindlichen, mittigen Implantatteil, das mit den endständigen Implantatteilen durch je ein Gewinde verbunden ist, wobei die beiden Gewinde in Längsrichtung der Wirbelsäule koaxial angeordnet sind und zueinander gegenläufigen Gewindesinn besitzen, so daß durch Verdrehen des mittigen Implantatteils die Länge des Implantats insgesamt veränderbar ist, alle drei Implantatteile als rohrförmige Hülsen mit zumindest im Bereich der Gewinde kreisförmigen Querschnitt ausgebildet und koaxial ineinander geschraubt sind, und wobei die Hülsenwände des mittigen Implantatteils von Aussparungen durchbrochen sind. The invention relates to an implant for insertion between vertebral bodies of the spinal column as a place holder for remote from the spine vertebrae or vertebra parts, consisting of two terminal, for bearing against the adjacent vertebrae particular implant parts and a therebetween, the central implant part with the terminal implant portions by a respective a thread is connected, wherein the two threads are arranged in the longitudinal direction of the spinal column are coaxial and mutually opposite thread direction have so that the length of the implant as a whole is variable by rotating the central implant part, circular, all three implant portions as a tubular sleeve with at least in the region of the threaded cross section and formed coaxially screwed into each other, and wherein the sleeve walls of the central implant part of recesses are broken.

Implantate dieser Art sind aus EP-A-0 567 424 bekannt, bei denen aufgrund der Dreiteiligkeit des Implantats mit der Verbindung über Gewinde eine einfache und einfach während der Operation zu handhabende Distraktionsmöglichkeit besteht. Implants of this type are known from EP-A-0567424, which, given the tripartite of the implant to the compound via threaded a simple and easy to handle during surgery Distraktionsmöglichkeit.

Aus US-PS 4 657 550 sind Implantate bekannt, die durch Verdrehen des mittigen Implantatteils eine Distraktion des das Implantat enthaltenden Wirbelsäulenbereichs ermöglichen. From US-PS 4,657,550 implants are known which allow by twisting the central implant part a distraction of the implant containing the spine area. Bei dem bekannten Implantat sind die beiden endständigen Implantatteile jeweils zweiteilig ausgebildet und bestehen je aus einer am angrenzenden Wirbel zur Anlage kommenden, zum Wirbel hin mit Dornen besetzten Druckplatte und einem Gewindebolzen, der mit einem Mehrkantkopf verdrehungsfest um die Bolzenachse in eine entsprechende Aufnahme in der Druckplatte eingesteckt ist. In the known implant the two terminal implant parts are each formed in two parts and each consist of one on the adjacent vertebral-engaging, to the vortex towards occupied with thorns pressure plate and a threaded bolt with a polygonal head twisting firmly around the bolt axis in a corresponding recess in the pressure plate is inserted. Das mittige Implantatteil ist mit Gewindebohrungen für die Aufnahme der Gewindebolzen ausgebildet. The central implant part is formed with threaded holes for receiving the threaded bolts. Dieses bekannte Implantat hat den Nachteil, daß nach dem Einsetzen des Implantats die Knochenbildung und -regeneration zu wünschen übrig läßt. This known implant has leaves that to wish bone formation and regeneration after insertion of the implant the disadvantage left. Aus der DE 34 35 771 A1 ist ein diesen Nachteil vermeidendes Implantat bekannt, das mit einer Vielzahl von Löchern versehen ist, jedoch ist ein solches Implantat als Platzhalter für einen Wirbel oder Wirbelteil ungeeignet. From DE 34 35 771 A1 this disadvantage avoidant implant is known which is provided with a plurality of holes, however, such an implant as a place holder for a vertebra or vertebral element is unsuitable.

In der EP 0 268 115 B1 ist ein als Platzhalter für einen Wirbel dienendes Implantat beschrieben, das als mantelförmiges Element mit Ausnehmungen in der Wandung ausgebildet ist, wobei der obere und untere Mantelrand wenigstens teilweise zackenförmig ausgebildet sind, um eine drehfeste Verbindung zwischen den zu verbindenden Wirbeln zu ergeben. In the EP 0,268,115 B1 a placeholder serving for an implant is described which is designed as envelope-shaped element with recesses in the wall, wherein the upper and lower cladding boundary are formed at least partly serrated in order to be connected to a rotationally fixed connection between the to yield vertebrae. Das Element ist aus einem mit den Ausnehmungen versehenen Blech ein- oder zweilagig gewickelt. The element is switched from a provided with the recesses or sheet wound in two layers. Durch die Ausnehmungen kann gewünschtenfalls ein in das Mantelinnere einzubringendes Material, wie Knochenzement oder Knochenstücke, eingefüllt werden, wodurch ein schnellerer Gefäßanschluß mit dem Implantat erreicht wird. Through the recesses can be filled if desired, to be introduced into the casing interior material such as bone cement or bone pieces, whereby a faster vessel connection is achieved with the implant. Nachteilig bei einem solchen Implantat ist, daß es keinerlei Distraktion der benachbarten Wirbel ermöglicht. A disadvantage of such an implant that it does not allow any distraction of the adjacent vertebrae.

Der Erfindung liegt die Aufgabe zugrunde, ein Implantat der eingangs genannten Art so auszubilden, daß es für die Induktion der Knochenbildung und Stimulation der Knochen besonders gut geeignet ist und daher nach der Implantation besonders leicht und schnell einwachsen kann. The invention has for its object to design an implant of the type mentioned, that it is particularly well suited for the induction of bone formation and stimulation of bone and therefore can very easily and quickly grow after implantation.

Diese Aufgabe wird nach der Erfindung bei einem Implantat mit den eingangs genannten Merkmalen dadurch gelöst, daß die endständigen Implantatteile das mittige Implantatteil außenseitig axial übergreifen, wobei die Gewinde jeweils als Außengewinde auf dem mittigen Implantateil und als Innengewinde in den endständigen Implantatteilen ausgebildet sind, und daß die Hülsenwände der endständigen Implantatteile von Aussparungen durchbrochen sind. This object is achieved according to the invention for an implant with the features mentioned in that the terminal implant parts engage over the central implant part outside axially, the thread are each formed as an external thread on the central Implantateil and as an internal thread in the terminal implant portions, and that the sleeve walls of the terminal implant parts of recesses are broken.

Die erfindungsgemäße Ausbildung des aus drei Hülsen bestehenden Implantats mit axial das mittige Implantatteil außenseitig übergreifenden endständigen Implanttteilen läßt im Implantatinneren einen durchgehenden Hohlraum großen Volumens entstehen, der durch die in den Hülsenwänden befindlichen Aussparungen hindurch überall mit der Implantataußenseite in Verbindung steht. The inventive construction of the three-sleeves implant with axially the central implant part externally overlapping terminal Implanttteilen can in the implant inside a through cavity large volume arise passing through the located in the sleeve walls recesses communicating anywhere with the implant outside. Dies gilt unabhängig vom Distraktionsstatus auch für die endständigen Implantatteile. This applies regardless of Distraktionsstatus for the terminal implant parts. Zusammen mit der Möglichkeit, den Hohlraum mit Knochenzement oder patienteneigenen oder fremden Knochenspänen zu füllen, läßt dies das Implantat schnell und zuverlässig einwachsen. Along with the possibility of filling the cavity with bone cement or the patient's own or someone else's bone chips, can it grow the implant quickly and reliably. Dennoch bleibt die Distraktionsmöglichkeit des Implantats während der Operation voll erhalten. Nevertheless, the Distraktionsmöglichkeit the implant during surgery is fully preserved. Die relative Zuordnung von endständigen und mittigen Implantatteilen hat weiterhin zur Folge, daß die Gewinde nach außen hin weitgehend durch die endständigen Implantatteile abgedeckt sind. The relative allocation of terminal and central implant parts further has the result that the threads are largely covered to the outside by the terminal implant parts.

Um im implantierten Zustand die Implantatteile gegen gegenseitiges Verdrehen zu sichern, kann mindestens eines der endständigen Implantatteile im Gewindebereich eine radiale Gewindebohrung aufweisen, in der eine gegen das mittige Implantatteil verspannbare Klemmschraube geführt ist, die im verspannten Zustand beide Implantatteile gegeneinander fixiert. To secure the implant parts against mutual rotation in the implanted state, at least one of the terminal implant parts, the threaded portion may have a radial threaded bore in which a braced against the central implant part clamping screw is guided, which fixes both implant parts against each other in the clamped state. Um die Hülsenwandung im Bereich der Klemmschraube zu stabilisieren, empfiehlt es sich, daß das mit der Klemmschraube versehene Implantatteil am axial innen liegenden Hülsenrand einen Ringbund mit im Vergleich zum restlichen Hülsenteil größerer Wandstärke aufweist und die Gewindebohrung für die Klemmschraube im Ringbund angeordnet ist. In order to stabilize the sleeve wall in the region of the clamping screw, it is recommended that the provided with the clamping screw implant portion at the axially inner edge of the sleeve is an annular collar with which compared to the remaining sleeve part of greater wall thickness and arranged the threaded bore for the clamping screw in the annular collar. Um eine ausreichend große Führungslänge der Klemmschraube in der Gewindebohrung zu erhalten, ist zweckmäßigerweise der Ringbund im Bereich der Gewindebohrung mit einem radial auswärts vorstehenden Vorsprung versehen. In order to obtain a sufficiently large guide length of the clamping screw in the threaded bore, the annular collar is advantageously provided in the region of the threaded bore with a radially outwardly protruding projection.

Vorzugsweise besitzt das mittige Implantatteil zwischen seinen beiden Gewinden einen gewindefreien Hülsenteil, in dem die Aussparungen gleichmäßig über den Hülsenumfang verteilt und als Schlüsselöffnungen zum Einstecken eines zum Verdrehen des mittigen Implantatteils dienenden Schlüssels ausgebildet sind. Preferably, the central implant part between its two threads has a thread-free sleeve portion in which the recesses uniformly distributed over the sleeve circumference and are formed as key openings for insertion of a serving to rotate the central implant part key.

Bezüglich der Ausbildung und Anordnung der Aussparungen außerhalb des gewindefreien Hülsenteils des mittigen Implantatteils besteht im Rahmen der Erfindung eine gewisse Wahlfreiheit. With respect to the design and arrangement of the recesses outside of the thread-free sleeve part of the central implant part consists in the context of the invention, a certain freedom of choice. Einerseits soll der von den Aussparungen insgesamt repräsentierte lichte Querschnitt möglichst groß sein, andererseits dürfen die Aussparungen die Gewindebereiche nicht unzulässig schwächen, damit die Festigkeit der Gewindeverbindung zwischen den Implantatteilen keine Beeinträchtigung erfährt. On the one hand the total represented by the recesses clear cross section should be as large as possible, on the other hand, the recesses must not unduly weaken the threaded portions, so that the strength of the threaded connection between the implant components undergoes no deterioration. Eine alle diese Forderungen besonders vorteilhaft erfüllende und daher im Rahmen der Erfindung bevorzugte Ausführungsform ist dadurch gekennzeichnet, daß die Aussparungen in den Implantatteilen im Bereich ihrer Gewinde vorgesehen und als Langlöcher mit in der Hülsenumfangsrichtung orientierter großer Lochachse ausgebildet sind. An all these requirements particularly advantageous fulfilling and therefore preferred within the scope of the invention embodiment is characterized in that the recesses provided in the implant parts in the region of their threads and are formed as long holes oriented in the circumferential direction of the sleeve large hole axis. Zweckmäßigerweise sind die Aussparungen in Richtung ihrer großen Lochachse in einer zur Hülsenachse senkrechten Ebene gereiht. Conveniently, the recesses are lined up in the direction of their large hole axis in a plane perpendicular to the sleeve axis. Zumeist wird man je Gewindebereich mehr als nur eine Lochreihe vorsehen. In most cases, will they ever threaded region provide more than just a row of holes. Dann sind bei mehreren Lochreihen im selben Gewindebereich die Aussparungen benachbarter Reihen in Umfangsrichtung zweckmäßigerweise gegeneinander versetzt. Then, at a plurality of rows of holes in the same threaded portion, the recesses of adjacent rows in the circumferential direction are advantageously offset from one another. Bei derartig versetzten Aussparungen liegen die Aussparungen der einen Reihe mit ihrer Aussparungsmitte vorzugsweise in der Mitte zwischen jeweils zwei aufeinander folgenden Aussparungen der benachbarten Reihe. In such displaced recesses, the recesses of one row lie with their recess center preferably in the middle between each two successive openings of the adjacent row. Im übrigen empfiehlt es sich, die Anordnung so zu treffen, daß die große Lochachse der Aussparungen länger, insbes. mehr als doppelt so lang wie der Randabstand zwischen den in jeweils der Reihe aufeinander folgenden Aussparungen ist, und daß der axiale Randabstand zwischen den in benachbarten Reihen angeordneten Aussparungen kleiner, insbes. etwa halb so groß wie die Länge der kleinen Lochachse ist. Incidentally, it is advisable to make the arrangement such that the large hole axis of the recesses longer esp. Is more than twice as long as the edge distance between in each case the series successive recesses, and that the axial edge spacing between the in adjacent is a series of recesses arranged less, especially about half as large as the length of the small hole axis.. Bei derartigen Aussparungsanordnungen bleiben zwischen den benachbarten Aussparungen genügend große und in sich zusammenhängende Gewindebereiche bestehen, die die Lastübertragung zwischen den Implantatteilen zuverlässig gewährleisten. In such arrangements remain recess between the adjacent recesses are made sufficiently large and coherent in itself threaded areas to ensure the load transfer between the implant parts reliable.

Im allgemeinen ist die Kraftübertragung zwischen dem Implantat und dem angrenzenden Wirbel allein über den dem Wirbel anliegenden Hülsenrand der endständigen Implantatteile möglich. In general, the power transmission between the implant and the adjacent vertebrae alone on the adjacent the vortex tube edge of the end implant parts is possible. Sollte aber dabei die spezifische Kraftbeanspruchung am Wirbel zu groß werden, besteht die Möglichkeit, den Hülsenrand zu verbreitern oder überhaupt mit einer Querplatte zu überdecken, die dann wiederum von Aussparungen möglichst durchbrochen sein sollte. but should examine the specific force stress on the vertebrae are too large, it is possible to widen the sleeve edge, or even to cover with a cross-plate should be in turn interrupted by recesses possible. Im übrigen wird der Hülsenrand für die Wirbelanlage in im wesentlichen einer Ebene verlaufen, die je nach den Erfordernissen im Einzelfall etwa senkrecht oder auch geneigt zur Hülsenachse gerichtet sein kann. Moreover, the sleeve edge of the vertebra engaging in is run essentially a plane which can be directed according to the requirements in the individual case approximately perpendicular or inclined to the sleeve axis. Selbstverständlich ist es aber auch möglich, daß der Hülsenrand in einer von einer Ebene abweichenden Fläche verläuft. but of course it is also possible that the sleeve edge extending in a direction deviating from a plane surface.

Weiter besteht im Rahmen der Erfindung die Möglichkeit, die endständigen Implantatteile an den angrenzenden Wirbeln dadurch gegen ungewünschte Verlagerungen zu sichern, daß der axial äußere Rand mindestens eines der endständigen Implantatteile mit einer oder mehreren, zum Eindringen in den angrenzenden Wirbel bestimmten Schneiden oder Spitzen versehen ist. Further, there is in the present invention the possibility to secure the terminal implant parts at the adjacent vertebrae thereby against undesired displacements that the axially outer edge of at least one of the terminal implant parts with one or more, provided for penetrating into the adjacent vertebra determined cutting edges or tips , Im einzelnen sind verschiedene Ausbildungen möglich. In particular, various configurations are possible. So kann die Schneide in Umfangsrichtung längs des Randes durchgehend oder von Lücken unterbrochen verlaufen. Thus, the cutting edge in the circumferential direction along the edge may be continuous or run interrupted by gaps. Die Schneiden können aber auch radial als Enden von längs des Randes aufeinander folgenden Vorsprüngen ausgebildet sein. However, the cutting may be formed as ends of along the edge of successive protrusions radially. Schließlich können die Spitzen von längs des Randes angeordneten, axial ausgerichteten Dornen gebildet sein. Finally, the tips may disposed of along the edge, axially directed thorns be formed. Um zu verhindern, daß die Schneiden oder Spitzen zu tief in die angrenzenden Wirbel eindringen, kann es sich empfehlen, daß am Implantatteil ein die Eindringtiefe der Schneiden oder Spitzen begrenzender, radial nach innen oder außen vorspringender Ringsteg vorgesehen ist, der als Anschlag für den angrenzenden Wirbelkörper dienen kann. In order to prevent the cutting or spikes penetrate too deeply into the adjacent vertebrae, it may be advisable, that there is provided on the implant part, the depth of penetration of the cutting edges or points limiting radially inwardly or outwardly projecting annular web, which adjacent a stop for the can serve vertebrae. Die radial äußere Randfläche dieses Ringstegs kann mit etwa axial gerichteten, konvexen Kanten versehen sein, die zum sicheren Sitz des Implantats beitragen. The radially outer peripheral surface of this annular rib may be provided with substantially axially directed, convex edges that contribute to a secure fit of the implant.

Im folgenden wird die Erfindung an in der Zeichnung dargestellten Ausführungsbeispielen näher erläutert; In the following the invention will be explained in more detail in the drawings exemplary embodiments illustrated; es zeigen: show it:

Fig. 1 Fig. 1
ein Implantat nach der Erfindung in einer Seitenansicht, an implant according to the invention in a side view;
Fig. 2 Fig. 2
das mittige Implantatteil des Implantats nach Fig. 1 in einer Seitenansicht, the central implant part of the implant of Fig. 1 in a side view;
Fig. 3 Fig. 3
den Schnitt III - III in Fig. 2, the section III - III in FIG. 2,
Fig. 4 Fig. 4
eine Seitenansicht eines endständigen Implantatteils in einer Ausführungsform mit im Vergleich zu dem Implantat nach Fig. 1 vergrößertem Durchmesser, a side view of an end implant part in an embodiment with compared to the implant. of Figure 1 on an enlarged diameter,
Fig. 5 Fig. 5
den Schnitt V - V in Fig. 4, the section V - V in Figure 4.
Fig. 6 Fig. 6
eine andere Ausführungsform eines endständigen Implantatteils nach Fig. 4, another embodiment of an end implant part according to Fig. 4,
Fig. 7 Fig. 7
den Schnitt VII - VII in Fig. 6, the section VII - VII in Figure 6.
Fig. 8 Fig. 8
den Schnitt VIII - VIII in Fig. 6, the section VIII - VIII in Figure 6.
Fig. 9 Fig. 9
den Schnitt IX - IX in Fig. 6, the section IX - IX in Figure 6.
Fig. 10 Fig. 10
eine nochmals andere Ausführungsform eines endständigen Implantatteils des erfindungsgemäßen Implantats in einer den Fig. 4 und 6 entsprechenden Darstellung, still another embodiment of a terminal implant part of the implant according to the invention in a FIGS. 4 and 6 corresponding representation,
Fig. 11 Fig. 11
den Schnitt XI - XI in Fig. 10, und the section XI - XI in FIG 10 and.
Fig. 12 Fig. 12
den Schnitt XII - XII in Fig. 11. the section XII - XII in FIG. 11.

Das in der Zeichnung dargestellte Implantat dient zum Einsetzen zwischen in der Zeichnung selbst nicht dargestellte Wirbelkörper der Wirbelsäule als Platzhalter für aus der Wirbelsäule entfernte Wirbel oder Wirbelteile. The implant illustrated in the drawing serves for insertion between itself is not shown in the drawing vertebral bodies of the spinal column as a place holder for remote from the spinal vertebra or vertebrae parts. Das Implantat besteht aus zwei endständigen, zur Anlage an den angrenzenden Wirbeln bestimmten Implantatteilen 1 und einem dazwischen befindlichen, mittigen Implantatteil 2. Dieses ist mit den endständigen Implantatteilen durch je ein Gewinde 3, 4 verbunden, wobei die beiden Gewinde in Längsrichtung der Wirbelsäule koaxial angeordnet sind und zueinander gegenläufigen Gewindesinn besitzen, wie dies insbes. aus Fig. 2 ersichtlich ist. The implant consists of two terminal, for bearing against the adjacent vertebrae particular implant parts 1 and wherein the two thread arranged in the longitudinal direction of the spinal column coaxially disposed therebetween, the central implant part 2. This is connected to the terminal implant portions by a respective thread 3, 4, and are mutually opposite thread direction have, as esp. in Fig. 2 can be seen. Dadurch wird erreicht, daß beim Verdrehen des mittigen Implantatteils 2 relativ zu den beiden endständigen Implantatteilen 1 die Länge des Implantats insgesamt geändert und dabei insbes. der mit dem Implantat versehene Wirbelsäulenbereich bei der Implantation distrahiert werden kann. It is thereby achieved that changed during the rotation of the central implant part 2 relative to the two terminal implant parts 1, the total length of the implant while esp. The implant provided with the spine area can be distracted during the implantation.

Die endständigen Implantatteile 1 übergreifen in axialer Richtung das mittige Implantatteil 2 auf dessen Außenseite, wobei die Gewinde 3, 4 jeweils als Außengewinde auf dem mittigen Implantatteil 2 und als Innengewinde in den endständigen Implantatteilen 1 ausgebildet sind. The terminal implant parts 1 overlap in the axial direction of the central implant part 2 on the outside, wherein the thread 3, 4 are each formed as an external thread on the central implant part 2 and as an internal thread in the terminal implant parts. 1 Beide endständigen Implantatteile 1 besitzen im übrigen im Gewindebereich eine radiale Gewindebohrung 5, in der eine gegen das mittige Implantatteil verspannbare, in der Zeichnung der besseren Übersicht wegen selbst nicht dargestellte Klemmschraube geführt ist. Both end implant parts 1 has a radial threaded hole 5 in which one against the central implant part braced, not shown in the drawing for clarity even clamping screw is guided in the rest of the threaded portion. Durch Verspannen dieser Klemmschraube jeweils gegen das mittige Implantatteil 2 werden die Implantatteile 1, 2 gegen gegenseitiges Verdrehen fixiert. By tightening this clamp screw respectively against the central implant part 2, the implant parts 1, 2 are fixed against mutual rotation. Dabei können die endständigen Implantatteile 1 am jeweils axial innen liegenden Hülsenrand einen Ringbund 6 mit im Vergleich zum restlichen Hülsenteil größerer Wandstärke aufweisen. Here, the terminal implant parts 1 can have an annular collar 6 with compared to the remaining sleeve part of greater wall thickness on the axially inside each sleeve edge. Die Gewindebohrung 5 für die Klemmschraube ist dann in diesem Ringbund 6 angeordnet, der das endständige Implantatteil gegen die bei der Verspannung der Klemmschraube auftretenden Kräfte stabilisiert. The threaded bore for the clamping screw 5 is then arranged in this annular collar 6 which stabilizes the terminal implant part against the occurring during the clamping of the clamping screw forces. Auch kann der Ringbund 6 im Bereich der Gewindebohrung 5 einen radial auswärts vorstehenden Vorsprung 7 erhalten, so daß in der Gewindebohrung 5 eine ausreichend große Führungslänge für die Klemmschraube zur Verfügung steht. Also, the collar 6 can receive a radially outwardly projecting protrusion 7 in the region of the threaded bore 5 so that a sufficiently large guide length for the clamping screw provided in said threaded bore. 5

Das mittige Implantatteil 2 besitzt zwischen seinen beiden Gewinden 3, 4 einen gewindefreien Hülsenteil 8. In diesem gewindefreien Hülsenteil 8 sind Aussparungen 9 gleichmäßig über den Hülsenumfang verteilt und als Schlüsselöffnungen zum Einstecken eines nicht dargestellten, zum Verdrehen des mittigen Implantatteils 2 dienenden Schlüssels ausgebildet. The central implant part 2 has between its two threads 3, 4, a thread-free sleeve part 8. In this thread-free sleeve part 8 recesses 9 are uniformly distributed over the sleeve circumference and is formed as key openings for insertion of a key, not shown, serving to rotate the central implant part. 2 Im Ausführungsbeispiel haben diese Schlüsselöffnungen die Form kreiszylindrischer Löcher, so daß der Schlüssel in besonders einfacher Ausführungsform lediglich von einem am Einsteckende kreiszylindrischen Stab gebildet sein kann. In the embodiment, this key openings have the shape of circular cylindrical holes so that the key can be formed in a particularly simple embodiment, only by a circular-cylindrical at the insertion rod.

Alle anderen Aussparungen 10 in den drei Implantatteilen 1, 2 sind im Bereich von deren Gewinde 3, 4 vorgesehen und als Langlöcher mit in der Hülsenumfangsrichtung orientierter großer Lochachse 11 ausgebildet. All other recesses 10 in the three implant parts 1, 2 are provided in the region of the thread 3, 4 and designed as an oblong holes oriented in the circumferential direction of the sleeve large hole axis. 11 Die Aussparungen 10 sind in Richtung ihrer großen Lochachse 11 in einer zur Hülsenachse senkrechten Ebene gereiht. The recesses 10 are lined up in the direction of its large axis of the hole 11 in a direction perpendicular to the sleeve axis. Im Ausführungsbeispiel nach den Fig. 1 und 2 sind im jeweils selben Gewindebereich 3, 4 zwei solcher Lochreihen vorhanden, während in den Ausführungsbeispielen nach den Fig. 4 bis 12 wenigstens drei Lochreihen vorgesehen sind. In the embodiment according to FIGS. 1 and 2 4 two such rows of holes are at the same respective threaded portion 3, available while three rows of holes are provided at least in the embodiments of FIGS. 4 to 12. Dabei sind die Aussparungen 10 benachbarter Reihen in Umfangsrichtung gegeneinander versetzt, wobei im einzelnen die Anordnung so getroffen ist, daß die Aussparungen jeweils einer der Reihen mit ihrer Aussparungsmitte in der Mitte zwischen jeweils zwei aufeinander folgenden Aussparungen der benachbarten Reihe bzw. Reihen liegen. The recesses 10 of adjacent rows in the circumferential direction are offset from each other, wherein in particular, the arrangement being such that the recesses in each case one of the rows lie with their cut-center in the middle between each two successive openings of the adjacent row or rows. Die große Lochachse 11 der Aussparungen 10 ist mehr als doppelt so lang wie der Randabstand 12 zwischen den in jeweils der Reihe aufeinander folgenden Aussparungen. The large hole axis 11 of the recesses 10 is more than twice as long as the edge spacing between the successive in each of the series following 12 recesses. Der axiale Randabstand 13 zwischen den in benachbarten Reihen angeordneten Aussparungen ist etwa halb so groß wie die Länge der kleinen Lochachse 14. The axial edge spacing 13 between the recesses arranged in adjacent rows is about half as large as the length of the small hole axis fourteenth

Im Ausführungsbeispiel nach den Fig. 1, 4 und 10 verläuft der axial äußere, zur Anlage am angrenzenden Wirbel bestimmte Rand 15 des endständigen Implantatteils 1 in einer zur Hülsenachse senkrechten Ebene. In the embodiment according to FIGS. 1, 4 and 10 of the axially outer, for bearing against the adjacent vertebral certain edge 15 of the end implant part 1 extends in a direction perpendicular to the sleeve axis. Im Ausführungsbeispiel nach Fig. 6 dagegen verläuft dieser Rand 15 in einer gegen die Hülsenachse geneigten Ebene, wobei im Ausführungsbeispiel der Neigungswinkel 10° beträgt. In the embodiment of FIG. 6, however, this edge 15 extends in a direction inclined against the sleeve axis, wherein in the exemplary embodiment, the inclination angle 10 °. Dieser axial äußere Rand 15 kann mit einer Schneide, wie in den Ausführungsbeispielen nach den Fig. 1, 10 und 12, oder, wie in den Fig. 4 und 6, mit längs des Randes 15 aufeinander folgenden Vorsprüngen 16 versehen sein, wobei die Schneiden bzw. Vorsprünge den Zweck haben, die endständigen Implantatteile 1 in ihrer Anlage an den angrenzenden Wirbeln gegen seitliche Versetzungen oder Verlagerungen zu sichern, indem die Schneide bzw. Vorsprünge mehr oder weniger tief in den angrenzenden Wirbel eindringen. This axially outer edge 15 can with a cutting edge, as in the embodiments of FIGS. 1, 10 and 12, or be provided as each other in Figs. 4 and 6, along the edge 15 following protrusions 16, wherein the cutting or projections have the purpose to secure the terminal implant parts 1 in its engagement with the adjacent vertebrae against lateral displacements or displacements by the cutting edge or projections penetrate more or less deeply into the adjacent vertebrae. Auch die Vorsprünge 16 können ihrerseits mit Schneiden versehen sein, die in Umfangsrichtung oder quer dazu orientiert sind, um das Eindringen der Vorsprünge in den Wirbel zu erleichtern. Also, the projections 16 may in turn be provided with cutting edges which are circumferentially or transversely oriented thereto, to facilitate the penetration of the protrusions into the vortex. Um dabei die Eindringtiefe zu begrenzen, kann, wie im Ausführungsbeispiel nach Fig. 1, am unteren endständigen Implantatteil 1 ein radial nach außen vorspringender Ringsteg 17 vorgesehen sein, der als Anschlag für den angrenzenden Wirbel dient. In order to limit the depth of penetration, as in the embodiment can, according to FIG. 1, a radially outwardly projecting annular web 17 may be provided at the lower end implant part 1 which serves as a stop for the adjacent vertebrae. Die äußere Randfläche des Ringstegs 17 ist mit axial gerichteten, nach außen vorstehenden, dh konvexen Kanten 18 versehen. The outer peripheral surface of the annular web 17 is provided with axially directed, outwardly projecting, that is, convex edges 18 provided.

Claims (17)

  1. An implant for insertion between vertebral bodies of the spinal column as spacers for vertebrae or vertebra portions which are removed from the spinal column, comprising two terminal implant portions (1) intended to bear against the adjoining vertebrae and a central implant portion (2) which is disposed between the terminal implant portions and which is connected to the terminal implant portions (1) by a respective screwthread (3, 4), wherein the two screwthreads (3, 4) are arranged coaxially in the longitudinal direction of the spinal column and have mutually opposite screwthread directions so that the length of the implant overall is variable by rotating the central implant portion (2), all three implant portions (1, 2) are in the form of tubular sleeves of circular cross-section at least in the region of the screwthreads (3, 4) and are coaxially screwed one into the other, and wherein the sleeve walls of the central implant portion (2) are apertured by openings (9, 10), characterised in that the terminal implant portions (1) axially engage over the central implant portion (2) at the outside, wherein the screwthreads (3, 4) are respectively in the form of a male screwthread on the central implant portion (2) and a female screwthread in the terminal implant portions (1), and that the sleeve walls of the terminal implant portions (1) are apertured by openings (10).
  2. An implant according to claim 1 characterised in that at least one of the terminal implant portions (1) has in the screwthread region (3, 4) a radial screwthreaded bore (5) in which is guided a clamping screw which can be tightened against the central implant portion (2).
  3. An implant according to claim 2 characterised in that the implant portion (1) provided with the clamping screw has at the axially inwardly disposed sleeve edge an annular collar (6) of a wall thickness which is larger in comparison with the remaining part of the sleeve and the screwthreaded bore (5) for the clamping screw is arranged in the annular collar (6).
  4. An implant according to claim 3 characterised in that the annular collar (6) has in the region of the screwthreaded bore (5) a radially outwardly protruding projection (7).
  5. An implant according to one of claims 1 to 4 characterised in that between its two screwthreads (3, 4) the central implant portion (2) has a thread-free sleeve portion (8) in which the openings (9 ) are distributed uniformly around the periphery of the sleeve and are in the form of wrench openings for the insertion of a wrench serving to rotate the central implant portion (2).
  6. An implant according to one of claims 1 to 5 characterised in that the openings (10) in the implant portions (1, 2) are provided in the region of their screwthreads (3, 4) and are in the form of elongate holes with their long hole axis (11) oriented in the peripheral direction of the sleeve.
  7. An implant according to claim 6 characterised in that the openings (10) are arranged in a row in the direction of their long hole axis (11) in a plane perpendicular to the sleeve axis.
  8. An implant according to claim 7 characterised in that when there are a plurality of rows of holes in the same screwthread region (3, 4) the openings (10) of adjacent rows are arranged in mutually displaced relationship in the peripheral direction.
  9. An implant according to claim 8 characterised in that in the case of displaced openings (10) those of the one row are disposed with the centre of their openings in the centre between each two successive openings of the adjacent row.
  10. An implant according to one of claims 7 to 9 characterised in that the long hole axis (11) of the openings (10) is longer than and in particular is more than twice as long as the edge spacing (12) between the openings which occur in succession in the respective row.
  11. An implant according to one of claims 7 to 10 characterised in that the axial edge spacing (13) between the openings (10) arranged in adjacent rows is less than and in particular is approximately half as great as the length of the short hole axis (14).
  12. An implant according to one of claims 1 to 11 characterised in that the axially outer edge (15) of at least one of the terminal implant portions (1) extends in a plane which is inclined with respect to the sleeve axis.
  13. An implant according to one of claims 1 to 12 characterised in that the axially outer edge (15) of at least one of the terminal implant portions (1) is provided with one or more cutting edges or points intended to penetrate into the adjoining vertebra.
  14. An implant according to claim 13 characterised in that the cutting edge is continuous or extends interrupted by gaps in the peripheral direction along the edge (15).
  15. An implant according to claim 13 characterised in that the cutting edges are radially in the form of ends of projections (16) which occur in succession along the edge (15).
  16. An implant according to claim 13 characterised in that the points are formed by axially directed spikes arranged along the edge (15).
  17. An implant according to one of claims 13 to 16 characterised in that provided on the terminal implant portion (1) is a radially inwardly or outwardly projecting annular flange (17) which delimits the depth of penetration of the cutting edges or points.
EP95107289A 1994-07-02 1995-05-13 Implant for maintaining the normal spacing between two vertebrae Expired - Lifetime EP0693274B1 (en)

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DE19944423257 DE4423257C2 (en) 1994-07-02 1994-07-02 Implant for insertion between vertebral bodies of the spinal column as a place holder
DE4423257 1994-07-02

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EP0693274A1 EP0693274A1 (en) 1996-01-24
EP0693274B1 true EP0693274B1 (en) 1999-03-17

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EP (1) EP0693274B1 (en)
JP (1) JP3680358B2 (en)
CA (1) CA2152707C (en)
DE (1) DE4423257C2 (en)

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